Health care providers oppose being taxed for Medicaid expansion

Health care providers oppose being taxed for Medicaid expansion

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SALT LAKE CITY — Health care providers started speaking out Wednesday against paying new taxes for the Medicaid expansion plan for low-income Utahns being advanced by Gov. Gary Herbert and legislative leaders.

"We don't think it's appropriate for one class, one group of people, to pay for a program that benefits everyone," said Dr. Mark Taylor, a Davis County optometrist who faces an annual tax starting at $244 under the plan known as UtahAccess+.

Taylor said the cost of expanding coverage to an additional 95,000 Utahns, including those in the so-called coverage gap who currently don't qualify for subsidies under President Barack Obama's health care law, should be picked up by all Utahns.

"I'm not a big fan of raising anyone's taxes," said Taylor, an eye doctor for 18 years. "It's a tough call. The services need to be there. And paying for it needs to be there. I think paying for it across the board is a more fair, a more realistic approach."

The Utah Optometric Association issued a statement Wednesday raising concerns about the proposal and suggesting it is not "balanced" because optometrists are excluded as providers for many Medicaid patients.

Dr. Terry Smith, a Salt Lake podiatrist who would be assessed about $600 in 2017, said doctors are already losing money by treating Medicaid patients because they are only able to charge them about half as much.

"To tax us again is essentially a double tax," Smith said, adding he would be willing to join other Utahns in paying higher taxes overall to help ensure health care coverage is extended.

"There's no question they need the care," the past state president of the Utah Podiatric Medical Association said. "It seems odd to target a particular group."


We don't think it's appropriate for one class, one group of people, to pay for a program that benefits everyone.

–Dr. Mark Taylor


Presented Tuesday to lawmakers, the plan calls for a long list of providers — including hospitals, doctors, pharmacies, podiatrists and nurses, as well as the state's 360 optometrists — to contribute more than $35 million starting in 2017. That total would rise to nearly $52 million by 2020, when the state will be responsible for coming up with about $78 million annually, 10 percent of the cost of the Medicaid expansion program.

The Utah Medical Association has already publicly opposed the proposed tax on doctors, which starts at about $800 and would increase to nearly $1,200 annually in 2021, according to calculations distributed to lawmakers.

The association told members it was "very concerned about implementation of a tax to physicians for anything as it becomes a funding source if the state has a budget shortfall or needs more money for programs."

Members of Legislature's Health Reform Task Force may get an earful from provider groups that would be affected by the new tax next Tuesday, when public testimony will be taken on the plan.

"Every group you tax becomes a potential opponent," said Greg Bell, president and CEO of the Utah Hospital Association and a former lieutenant governor. "They can all hire lobbyists."

By 2020, hospitals would be assessed close to $25 million under the plan, the same amount they've been offering to pay for nearly a year. Bell said only hospitals "made a concrete, firm proposal" for helping to fund the plan.

But he said the hospital association also brought up alternative sources of revenue during discussions with the governor and legislative leaders, including restoring the state's 4.7 percent sales tax on food purchases and taxing e-cigarette products.

"There was a laundry list of ideas," Bell said. "But at this point, I think it's way late to be talking about that because you've got a very small window to vote up or down on this thing. I think no one wants to complicate it."

House Speaker Greg Hughes, R-Draper, is credited with coming up with the new tax. Hughes has declined to discuss the reaction to the plan by House Republicans, who heard details for the first time Tuesday in a closed caucus.

House Majority Leader Jim Dunnigan, R-Taylorsville, said Wednesday that he and Hughes talked after the caucus about the chances of the plan passing with the current tax structure intact.

"Neither one of us are willing to handicap it. There's a lot of unknowns," Dunnigan said. "There was some discussion in our caucus about modifying the payment mechanism, but pretty much it's the plan that has been presented."

Related

In the 2015 Legislature, House Republicans blocked the governor's Healthy Utah alternative to Medicaid expansion, a two-year pilot program that would have utilized state funds.

That led Herbert to bring together Hughes, Dunnigan, Senate President Wayne Niederhauser, R-Sandy, and Sen. Brian Shiozawa, R-Cottonwood Heights, to put together a new plan.

The governor, who has yet to sign off on the details of UtahAccess+, has said he hopes to call lawmakers into special session in mid-October to act on the plan, but it's not clear there is enough support, especially in the House.

Herbert spokesman Jon Cox said recently the governor "appreciates the leadership of Speaker Hughes, who has worked tirelessly in his effort to help Utah resolve one of Obamacare's most egregious mistakes."

Cox said because of Healthy Utah, the governor "understands how difficult it can be to balance the competing interests of taking care of the most vulnerable in our society while also protecting taxpayers and promoting individual responsiblity."

Dunnigan, who said another House GOP caucus will be held on Oct. 13 to count votes, encouraged supporters and opponents of the plan and the new tax to contact their lawmakers.

Additional opposition from provider groups over the new tax will have an effect, the majority leader said.

"I don't know if it kills it," he said. "It will make a difference."

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Lisa Riley Roche

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